The only thing preventive health care maneuvers have done for me personally is to engender a sense of guilt anytime one of my patients gets sick. Remember Dr. Dell? Apparently he fell down a well and fractured his clavicle; the poet of old, reporting the event, concluded that doctors should treat the sick and leave the well alone.
But not today. Now we have task forces and preventive services and anybody with a cause busily recommending that we doctors go peering down wells and up every orifice available. Special interest groups make demands. Perfect example is the prostate cancer crowd. Would be great to just take a blood test and say "You got cancer." Actually it would be even better to say, "You don't have cancer." Too bad we can't say either.
The digital rectal exam (DRE) isn't any more sensitive or specific. Pity the biopsy (basically blind). Ten results, all useless if negative. "We'll have to do it again." Still, despite all the fuss on posters, the scientific evidence for prostate screening is (in Canada) a level D: basically useless. Perhaps even worse than useless. Perhaps actually harmful.
Ovarian cancer, pancreatic cancer, sputum cytology for lung cancer, dipstick for bladder cancer: the list flows on and on; and, while we feel empathy for such afflicted individuals, screening here doesn't work. Not as much as we'd like, or need, to believe. The false premise is that early detection will help us cure these diseases. Works with infectious diseases but not for most cancers.
We're stuck with past logic. With infections like tuberculosis and AIDS early detection will save lives by offering early treatment and contact isolation to prevent further spread. Not so with cancers, most of which will have spread long before our probes and scopes and blood tests are able to detect them.
Another perspective: when a sick patient comes to see us he or she knows somewhere deep down that we might not be able to cure. This, to a greater or lesser extent, is as it always has been. But when we offer screening to a complaint-free individual and we find a disease, the individual (now a patient) rightly assumes that we actually have a cure. By offering up early diagnosis for conditions we can't really treat we harm the patient not the least by dashing trust in both the individual we and the greater us.
We need more empathy and less sympathy.
Sympathy is the facility to experience the emotion of your patient while empathy is the ability to recognize such emotion. When sympathetic, we experience our patient's sensations and act on such feelings. Because we are helpers and healers we feel compelled to diagnose and treat. But we are acting on our Limbic system-driven emotions which override our conscious, logical behavior. Empathy allows us to pursue the cure while keeping the patient's perspective at the top of our agenda.
Too much feeling for the patient's plight might overwhelm our ability to cope with failure making us forget the patient as we devote ourselves to tests and treatments. Hurry sickness can lead to our burnout as we become zealots to the false prophet of early detection.
Medicine is a conservative profession so we keep thinking like we have done for hundreds of years, thousands perhaps. We keep working hard to cure sick people using the logic of the centuries. Arguments like, "Well we've got to do something!" while fascinating to some, are tired and old. The mantra seems to be "If you can't cure the patient at least be busy."
Looking back we note that King George III of England was phlebotomized for liters of blood, strapped to a chair, made to eat poisons, and was therapeutically stung by bees in an attempt to cure his porphyuria. What is the difference, I ask, between such "doing something" for doings sake then and today?